673: Resource Utilization of PICUs in U.S. Children’s Hospitals over Time

Abstract

Introduction: With growing concerns over cost of healthcare, understanding allocation of resource-intensive PICU beds is fundamental. We examined PICU resource-utilization in US children's hospitals over time. Methods: We analyzed all hospital discharges for pts <22 yrs in PHIS database from 2002-2011. We created random coefficients models to assess proportion of total number of pts who utilized PICU during hospitalization and utilization of vasoactive medication or mechanical ventilation in PICU over time. Tests were 2-sided with alpha equal to 0.05. We calculated descriptive statistics for multiple variables for severity of illness and patient outcomes for 2002 and 2011. Results: 320,463 cases discharged from 28 hospitals in 2002 versus 655,880 cases discharged from 40 hospitals in 2011. 14.6% of total hospital discharges utilized PICU in 2002 vs 13.0% in 2011. In all years, almost half of PICU pts used vasoactive medication and/or mechanical ventilation. Consistently, ~30% of PICU discharges used vasoactive medication and 35-40% required mechanical ventilation. Comparing 2002 to 2011, expected mortality for all hospital discharges and for PICU discharges increased over time, but actual mortality decreased. For total hospital discharges, average expected mortality was 7.6 deaths per 1000 pts in 2002 and 8.5 deaths per 1000 pts in 2011 (11.8% difference). For PICU discharges, expected mortality was 30.6 deaths per 1000 pts in 2002 and 36.8 deaths per 1000 pts in 2011 (20.3%). Actual mortality decreased from 9.3 to 6.3 deaths per 1000 pts for total hospital discharges and from 41.4 to 29.1 deaths per 1000 pts for PICU discharges. Expected LOS for both populations increased while actual LOS decreased. Conclusions: Though patients in US children's hospitals and in their PICUs are sicker on average in more recent time, the same proportion of patients utilize PICU beds, vasoactive medications, and mechanical ventilation. Mortality and length of stay statistics suggest that patients, even though sicker, are on average achieving better outcomes in more recent time.